Health care for all

For people who barely manage to earn their daily keep, getting gravely ill is a no-no. Even with the passage of the Universal Health Care (UHC) Act in 2019, the aim of protecting the right to health of all Filipinos remains a challenge despite the billions of pesos in state subsidies received yearly.

A well-known fact among indigent patients is the double standard of hospitals and staff in providing treatment. The charity wards are a sad sight where service is slower, or even negligent, and sometimes left unmanned for hours by a doctor.

As with the enhanced Z package, a suite of benefits designed by the Philippine Health Insurance Corp. (PhilHealth) for patients needing prolonged and expensive medical care, the allocated amounts are often not enough to defray the whole cost.

Many are familiar with the plight of those afflicted by end-stage renal disease, where the progressive deterioration of health will require increasing frequency of dialysis treatments on the patient. While the coverage of the Z package has been extended from 90 to 144 sessions in a year, queueing is a reality given the limited facilities in government hospitals.

A session of hemodialysis could cost anywhere from P2,000 to P7,000 depending on where one would go. The bigger private hospitals, of course, charge higher, which means that the PhilHealth’s reimbursement under its Z package would more often cover less than half of the bill.

Patients who keenly watch their spending will often go to government hospitals like the National Kidney Transplant Institute, where they have to shell out a few hundred pesos instead of thousands for a daily treatment. If the patient requires three sessions a week, that few hundred pesos could be a significant drain on his savings, especially if he is no longer working.

State subsidies and premium contributions

Our government’s aspiration to provide adequate health care to all Filipinos is laudable, but has always been constrained by the total cost. PhilHealth, for example, is asking P100.23 billion next year to support its programs as well as to expand health benefits for kidney transplantation, cancer, and severe malnutrition.

The subsidy allocation for PhilHealth is the highest among government-owned and government-controlled companies, more so during the pandemic where the extraordinary COVID-19 health-related costs like testing and hospital treatment were fully or partially covered.

With the government now moving toward a “living with the virus” stance, COVID-19 related expenses are expected to taper, especially with more Filipinos now protected from the virus through vaccination, and thus requiring home care only if testing positive.

PhilHealth, however, is not just pushing for more funds to expand its financial coverage on benefits, but also to compensate for lost income from premium contributions, which under the law was supposed to be raised to 3.5 percent in 2021 from three percent the previous year. PhilHealth claims that the suspension of the contribution rate hike had contributed to a dip in earnings and slightly affected its actuarial health.

This year, PhilHealth was able to pursue the mandated four percent increase in premium contributions, which is expected to assure the state health insurance agency of a stable source of funds. PhilHealth is looking forward to an increase of 4.5 percent next year and five percent from 2024 to 2025.

Aside from the national government’s budget allocations and premium contributions, PhilHealth is also dependent on remittances from the Philippine Charity Sweepstakes Office (PCSO) and the Philippine Gaming Corp. (Pagcor) as specified under the UHC Act.

All these funding sources are expected to arm the UHC law with the sustainability it needs to protect the health of the nation, even if at least partially, while the population grows to 115 million by 2025, possibly 123.7 million by 2030, and 144.45 million by 2050.

New look at health

Filipinos living in developed economies under changed citizenships often boast of the enviable health care benefits that their new host countries are able to give, especially as they grow older after retirement when they most need financial support for their ailing health.

If you consider the US Department of Health and Human Services’s budget in 2022 of $2.82 trillion, of which $767 billion was allocated to Medicare, or the equivalent of our PhilHealth, it is easy to see how much more the US government allocates to its citizens (pop. 332.4 million) for health care.

Thus, it is easy to believe when our Department of Health says that its proposed P296.3 billion budget next year is barely enough to provide adequate basic health care coverage for all Filipinos, much more to respond to health emergencies like a pandemic.

Unfortunately, the Philippines is still a developing economy, and as such, will continue to struggle on a severely restricted budget when it comes to the provision of government services for health. Given our limited resources, and the need to prepare for possibly new and more health crises, better use of state funds must be pursued.

In keeping with new health care trends, prevention of health problems must be vigorously pursued. We’ve made a good start with introducing heavy taxation on tobacco use and alcohol drink intake, and new initiatives to tax sugary drinks.

While these actions are punitive by discouraging health-threatening behavior through increased consumption costs, encouraging healthier lifestyles could contribute significant gains that would lessen the spending of government on healthcare delivery.

Campaigns promoting the intake of fresh foods, an observance of balanced diets rich in vegetables, proper exercise, and a balanced work-life relationship where stress is avoided are good prescriptions that prevent severe health problems.

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